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Cochrane Database of Systematic Reviews

Incentivos para la prevención del hábito de fumar en niños y adolescentes

Information

DOI:
https://doi.org/10.1002/14651858.CD008645.pub3Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 06 June 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Tobacco Addiction Group

Copyright:
  1. Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Marita Hefler

    Correspondence to: Wellbeing & Preventable Chronic Disease Division, Menzies School of Health Research, Darwin, Australia

    [email protected]

  • Selma C Liberato

    Wellbeing & Preventable Chronic Disease Division, Menzies School of Health Research, Darwin, Australia

  • David P Thomas

    Wellbeing & Preventable Chronic Disease Division, Menzies School of Health Research, Darwin, Australia

Contributions of authors

Marita Hefler, with David Thomas, assessed the quality of the studies and risk of bias of the included studies. Marita Hefler prepared the first draft of the updated review and revisions.

Selma Liberato performed the reanalyses of data for this review and the meta‐analysis, assisted with the development of this review and provided critical comment and revision of the draft manuscript.

David Thomas conceived of this review. Together with Marita Hefler, he assessed the quality and risk of bias of the included studies

Sources of support

Internal sources

  • Marita Hefler, Australia.

    Salary support received from Menzies School of Health Research.

  • Selma Liberato, Australia.

    Salary support received from Menzies School of Health Research.

  • David P Thomas, Australia.

    Salary support received from Menzies School of Health Research.

External sources

  • No sources of support supplied

Declarations of interest

None known

Acknowledgements

Vanessa Johnston was the first author of the first version of this review. She developed the search strategies, undertook the initial screening of retrieved records, extracted data from the eligible studies and (with David Thomas) assessed the quality of the studies and risk of bias of the included studies. She also prepared the first draft of the first version. We would like to thank Lindsay Stead of the Cochrane Addiction Group, who completed electronic searches for and pre‐screening of studies for possible inclusion in this review. We would also like to thank Stephanie Stucki for supplying additional data for this update.

Version history

Published

Title

Stage

Authors

Version

2017 Jun 06

Incentives for preventing smoking in children and adolescents

Review

Marita Hefler, Selma C Liberato, David P Thomas

https://doi.org/10.1002/14651858.CD008645.pub3

2012 Oct 17

Incentives for preventing smoking in children and adolescents

Review

Vanessa Johnston, Selma Liberato, David Thomas

https://doi.org/10.1002/14651858.CD008645.pub2

2010 Aug 04

Incentives for preventing smoking in children and adolescents

Protocol

David Thomas, Vanessa Johnston

https://doi.org/10.1002/14651858.CD008645

Differences between protocol and review

We have included a 'Summary of findings' table to this review update (2017).

Keywords

MeSH

Medical Subject Headings Check Words

Adolescent; Child; Humans;

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

PRISMA study flow diagram of search results
Figures and Tables -
Figure 1

PRISMA study flow diagram of search results

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

Comparison 1 Incentive versus control. Randomized and non‐randomized controlled studies (adjusted for clustering), Outcome 1 Smoking uptake at longest follow‐up (RR).
Figures and Tables -
Analysis 1.1

Comparison 1 Incentive versus control. Randomized and non‐randomized controlled studies (adjusted for clustering), Outcome 1 Smoking uptake at longest follow‐up (RR).

Study

Number of non‐smokers at baseline

Number of smokers at endpoint who reported not smoking at baseline

Time point

Outcome

Biological criterion

Results

Secondary outcomes (dose response, cost, harms)

Crone 2003

556 intervention; 420 control (data from authors)

112 intervention; 88 control

 

 

19 months

Smoking = current smoking, including daily/weekly/experimental

Not biochemically verified

Not reported at 19 months in published paper.

Our reanalysis: RR 0.92 (95% CI 0.53 to 1.61)

Not reported

Isensee 2012a

430 never‐ smokers in intervention; 610 never‐smokers in control (data from authors)

136 intervention; 184 control

19 months

Smoking = ever smoking, even just a puff

Not biochemically verified

From published paper: Authors reported that no group differences were found in the frequency of smoking initiation but data not presented in paper.

Our reanalysis:  RR 1.05 (95% CI 0.80 to 1.38)

Bullying (Hanewinkel 2010):  "When compared with control classrooms on all three dependent variables – being victimised, active bullying or being isolated – the adjusted ORs indicated no significant differences at post‐test for any of the IGs [Intervention Groups]".

Schulze 2006

591 never‐smokers in intervention; 449 never‐smokers in control

224 intervention; 173 control

24 months

Smoking = current smoking, including irregular (less than weekly) smoking

Not biochemically verified

From published paper: 62.1% remained ‘never smoker’ in intervention group at follow‐up versus 61.4% in control group: OR 1.02 (0.83 to 1.24) adjusted for age, sex and school type.

 

Our reanalysis:  RR 0.98 (95% CI 0.77 to 1.24)

Not reported

Figures and Tables -
Analysis 2.1

Comparison 2 Results of included studies, Outcome 1 Results table: RCTs.

Study

Number of non‐smokers at baseline

Number of smokers at endpoint who reported not smoking at baseline

Time point

Outcome

Biological criterion

Results

Secondary outcomes (dose response, cost, harms)

Comment

Burke 1992

Not reported

Not reported

18 months

Mean (SD) score of 5‐category self‐definition of smoking and 10‐category self‐reported frequency

Salivary thiocyanate (TCN)

From published paper:  Mean TCN at follow‐up of pre‐intervention never‐smokers higher (560 mcg/mL, SD 403) versus control (514 mcg/mL, SD 424).

Primary outcome for this review not available.

Not reported

Kairouz 2009

664 intervention; 915 control

93 intervention; 165 control

10 ‐ 18 months

Smoking = ever smoking, even just a puff

Not biochemically verified

From published paper: OR 0.8 (0.5 to 1.1), adjusted for age, gender, school location, social deprivation index.

Our reanalysis: 

RR 0.81 (95% CI 0.55 to1.20)

Intervention participants more likely than control participants to report that people “should not hang out with smokers” (14% versus 11%) and that they, themselves would “not want to be friends with a classmate who smokes” (28% versus 25%)

Concerns about misreporting of smoking status.  Note large numbers of ever‐smokers at baseline then denying ever smoking at follow‐up.  Stat sig more in intervention vs control (24% vs 16%)

Stucki 2014

544 intervention, 378 control

39 intervention,

24 control

About 7 months

Smoking = any smoking in last 6 months, even just a puff and smoking during the previous month

Not biochemically verified

From published and additional data from authors. OR for decreased smoking prevalence 0.7, CI 0.5 to 1.0

Increased smoking‐related knowledge b ‐1.0, P < 0.01

Vartiainen 1996

Not reported and not available from authors

Not reported and not available from authors

18 months

Smoking = daily smoking

Not biochemically verified

Reports only on the increase in prevalence of smoking from baseline to follow‐up. From baseline to longest follow‐up, increase by 10.8% points in Intervention group vs 11.2% points in control group: OR 1.25 (P = 0.15).

Primary outcome for this review not available.

Not reported.  Except in discussion – authors report "The social pressure created by the competition process was not greatly criticised in the pupils’ answers."

Wiborg 2002

1215 intervention group; 502 control

(data from authors)

207 intervention; 107 control

12 months

Smoking = 4 week prevalence of smoking

Not biochemically verified

From published paper: OR 1.36 (1.04 to 1.76), adjusted for age, sex, smoking status at baseline

Our reanalysis: 

RR 0.81 (95% CI 0.53 to 1.23)

Cost benefit (Hoeflymayr 2008). Cost benefit ratio: economic modelling based on estimates of reduced smoking prevalence in Intervention group and models of assumed future smoking behaviour and cessation. Not based on prevention of initiation

Figures and Tables -
Analysis 2.2

Comparison 2 Results of included studies, Outcome 2 Results table: non‐randomized CTs.

Smokefree Class Competitions (SFC) for preventing smoking uptake

Patient or population: Children and adolescents aged 5 ‐ 18 years who were non‐smokers at baseline

Settings: Schools in Germany, the Netherlands, Finland, Switzerland, Canada and the United States

Intervention: Participation in SFC

Comparison: No participation in SFC

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants

Actual number/

effective number2
(studies)

Quality of the evidence
(GRADE)

Assumed risk1

Corresponding risk

Smoking uptake at longest follow‐up (RCTS)

317 per 1000

320 per 1000

RR 1.00 (0.84 to 1.19)

3056/1108

(3)

Low3, 4

Smoking uptake at longest follow‐up

(Non‐RCTs)

158 per 1000

132 per 1000

RR 0.82 (0.63 to 1.08)

4219/1377

(3)

Very low3, 5, 6

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk Ratio; RCT: Randomised Controlled Trial

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1'Assumed risk' calculated as risk in control groups.
2Adjusted for clustering.
3Downgraded one level due to imprecision. All studies included had a wide confidence interval.
4Downgraded one level due to risk of bias. 2/3 studies judged to be at high risk of attrition bias.
5Downgraded one level due to observational (non‐RCT) study type.
6Downgraded one level due to risk of bias. 2/3 studies judged to be at high risk of selection bias, most other bias risks unclear.

Figures and Tables -
Comparison 1. Incentive versus control. Randomized and non‐randomized controlled studies (adjusted for clustering)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Smoking uptake at longest follow‐up (RR) Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 RCTs

3

1108

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.84, 1.19]

1.2 Non‐randomized CTs

3

1377

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.63, 1.08]

Figures and Tables -
Comparison 1. Incentive versus control. Randomized and non‐randomized controlled studies (adjusted for clustering)
Comparison 2. Results of included studies

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Results table: RCTs Show forest plot

Other data

No numeric data

2 Results table: non‐randomized CTs Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 2. Results of included studies